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The title of this review could be ‘Why we all need to read more books about death’. This is because a book like Paul Kalanithi’s reflective journey, following a diagnosis of incurable lung cancer, is a poignant reminder that when we lose sight of our mortality, we can also too easily lose sight of what is important, and what is not, in the way we live. Keeping our eyes averted from the inevitability of our own death (even if we hope it is a distant event) can have the strange effect of making our daily lives less lively, more deadened, as we become weighed down by minutiae of everyday living and our well worn habits.

Kalanithi’s life story was one of great expectations (from his parents) and high achievement. Originally rejecting medicine as a career because of his cardiologist-father’s many absences, Kalanithi first studied humanities but later felt drawn medicine and began the grueling process of training to be a doctor. His chosen specialty, neurosurgery, is an arduous one, and he recounts his battle to maintain his humility and compassion through the backbreaking long hours, and the heavy weight of responsibility in dealing with the hope of living and the fear of dying that permeates hospitals: “At moments it became palpable. It was in the air, the stress and misery….Some days this is what it felt when I was in the hospital: trapped in an endless jungle summer, wet with sweat, the rain of the tears of the families of the dying pouring down.” (p. 78)

At the age of 36, after nearly 10 years of training as a neurosurgeon, Kalanithi was diagnosed with lung cancer. Initial treatment seemed positive, but then stopped working. Kalanithi details his struggles when the fantasy of his longevity was shattered. Used to being both a midwife of life and death as a doctor, confronting his own death created a variety of conflicts for him in his roles of doctor and patient, husband and son.

In the face of a diagnosis of incurable diseases, many patients ask their doctors for hope of survival via statistics. However, as Kalanithi tussled with finding a way of learning to live with some kind of authentic hope for his own future, he found that “getting too deeply into statistics is like trying to quench a thirst with salty water. The angst of facing morality has no remedy in probability.” (p. 135).

Through his work as a doctor, Kalanithi had dedicated his life to helping patients who came face to face with their own death. With his diagnosis of incurable cancer this daily contact with death became a struggle for his own shortened existence. One of the themes that threads its way through this book is how Kalanithi sought and fought, both avoiding the gaze of death, and looking at it head on, so as to wring all the possible life he could from the time he had left. Kalanithi describes in moving detail the inevitable ducking and twisting from the reality of what he confronted, and the solace he found in his relationships, in reading and writing literature, and in the birth of his daughter, 8 months before he died.

Kalanithi very much wanted to complete the book that was eventually published as “When Breath Becomes Air”, as it served as a coming together of his passions as a doctor and a scholar of literature, and was a creative endeavour in the face of his impending death. In the end, Kalanithi became too ill to complete the book as he wanted to, but the final epilogue chapter, written by Kalanithi’s wife about his last months, is all the more poignant as a result. Paul Kalanithi’s book is on the one hand a story about death, but on the other is a call to living as fully as is possible. As a legacy, it is a powerful one.

Whatever the stage of parenting one is at­, there is a plethora of (often conflicting) advice out there about how best to go about it. The maxim goes that we write about what troubles us: if this is the case, then clearly parenting is something that bothers a lot of us.

Becoming responsible for a child the first time is an experience of dizzying proportions. For mothers, fathers, and caregivers, adapting to being responsible for one’s own body to suddenly coordinating the care of two bodies requires a complex array of physical and psychological alterations. The labour involved in coming to terms with this change is immense, and is made more complicated by the way we have to adapt ourselves as parents to the realities of the child we are looking after; children invariably develop into different people to what we expect them to be, and adjusting for this difference between ideal and reality is not necessarily straightforward or easy.

Becoming a parent can be a time of exploration, providing caregivers with an opportunity to play creatively in a way that they might have forgotten or lost touch with as they got older. But it can also be a very challenging process because of the way parenting tends to stir up our own unresolved feelings and tensions from childhood. This can happen at any stage, and can be particularly confusing if, for example, early stages of parenting have gone relatively smoothly, but then become much more tense in later stages. Parenthood then becomes a tricky process of working out what belong to the child, and what belongs to the parent’s own past.

Another source of tension in the transition to parenthood is the inevitable different perspectives on what it means to ‘parent well’ between caregivers. We all have some ideas about what it means to be a good parent—a view influenced by what we feel was done well, or not done well, by our own parents. If these differences are large, and are not talked about and worked through in some way between caregivers, the dissimilar approaches in parenting can create significant tension within a family unit.

Transitioning in parenthood is not something that is restricted to the early phases. Because children are constantly developing, their needs and desires are also in a state of flux. Being a parent is therefore a process of continually being in a state of transition. The skills of being a parent to an infant or toddler are different those required when parenting an adolescent. Parenting is in some ways a constant lesson in letting go of the old, in order to understand the new—a rich learning process but one that requires a lot of energy and resource and where fallibility is inevitable.

Given the inevitability of failing at the task of parenting, at least in some measure, it can be helpful to be reminded of the conclusion reached by paediatrician and psychoanalyst Donald Winnicott after observing hundreds of mother-infant pairs. He noted that failing in some moderated degree (i.e. not in ways that are not too traumatic for the child) is an important part of parenting and that children can benefit from this, as it allows them space to develop their own sense of identity and resilience. The aim for parenting, therefore, is not perfection, but striving for being ‘good enough’ (Winnicott, 1953).

Addiction is a word that causes great fear—to be addicted indicates a compulsive need or drive towards something that promises good feelings but actually, over time as a habitual pattern develops, causes the addicted person great harm. In the past, addiction tended to be viewed as a moral weakness, experienced by some people in society: ‘weak’ addicts were to be pitied (and perhaps privately derided) by ‘strong’ non-addicts.

These days, however, increased understanding of human development has led to addiction being seen more as a pathological relationship to substances or things—one that serves as a convenient avoidance of relating to other people and ourselves. People, like many other animals, are naturally relationship-seeking creatures. Problems in early relationships (e.g. in childhood), however, can make relating to other people a frightening prospect. So, rather than seeking good feelings from relating to others, some people find themselves seeking highs from substances (e.g. drugs or alcohol) or activities (e.g. eating, watching porn, the playing of online games).

If we encounter problems relating to others because we have been badly let down in the past by important people in our lives, addiction to substances or activities might feel like a relationship—and one that is more reliable than depending on other people, and less painful than delving into our own feelings and desires. However, as Marc Lewis (2018) notes, the notion of addiction being a relationship is an illusion because addiction is always a very one-sided connection.

Unlike when we relate to other people, the substance or activity that we are addicted to does not respond to us, instead we respond to it adaptively. And this process of adaptation creates dreadful physical and psychological side effects: an addiction to an activity or substance is like forming a friendship with someone who initially seems to offer a lot, but in the end only takes from you.

This new understanding of addiction as a struggle to relate helps us to understand that rather than being a problem that is restricted to a few members of society, it is a pattern that most of us struggle with—albeit in varying degrees. The addictions we readily identify as problematic include street drugs, alcohol, porn and gambling. But addiction can be anything in excess; other activities such as compulsive checking of the news on phones, shopping, and bingeing on Netflix can also end up as hard-to-break habits that are life-restricting, cutting us off from others and from our own internal thoughts and feelings.

Therapy can be a helpful way of exploring the underpinning structures of addiction—what kinds of feelings are being sought through the addiction, what is being avoided, and ways of working towards a fuller life through relationship with real people and self.

There is no light without shadow and no psychic wholeness without imperfection. To round itself out, life calls not for perfection but for completeness; and for this the “thorn in the flesh” is needed, the suffering of defects without which there is no progress and no ascent. (C.G Jung, Collected Works, Volume 12, para 208).

Swiss psychoanalyst Carl Jung thought that our psyche was comprised of different elements. Some of these elements (such as the persona and ego) are outwards facing, representing how we appear and interact with the world. Others (such as the anima/animus and shadow) are inwards facing, giving shape our internal world. For Jung and others, one of the challenges of human psychology is that we are often out of touch with these inwards facing elements of our psyche, existing as they do in our unconscious.

Jung had a particular interest in the shadow element of the human psyche, seeing it as the component that contains the parts of ourselves, and our relationships, that we want to disown. For reasons of social pressures and our own personal life experiences, we tend to not only reject difficult feelings and attitudes like being judgmental or hating, but also can deny ourselves access to good qualities such as creative impulses and the ability to be assertive.

The problem with being out of touch with our shadow is that it creates a kind of impoverishment in our psyche, depriving us of energy, weakening and atrophying the range of relationships and connections we have within ourselves and with other people. Disavowing our shadow side is a bit like trying to create paintings with a very limited palette of colours–the resulting paintings lack depth and diversity.

Being out of touch with the full range of human feelings not only limits how we experience ourselves, but also what we are able to encounter and experience in our relationships with others. An example could be someone who views being angry as unacceptable. With the ability to express anger hidden away in their shadow, such a person will tend to go through life not being able to direct their anger outwards, even in situations that warrant it. It is also likely that someone who finds it impossible to express their anger will find it very hard to process and respond to another person’s anger in a constructive way.

Importantly, Jung linked the shadow with our creative potential. His own personal experiences, and his work as an analyst, showed him that getting in touch with and beginning to accept what is in our shadow releases our creative capacities–both in how we experience ourselves and others. Learning what it is that we have consigned to our shadow thereby frees us respond much more fully and creativity to life events and other people.

The English-speaking world has been a bit slow on the uptake regarding graphic novels. If you go into a bookshop in France, on the other hand, you will find a huge variety of graphic novels and comics in multiple genres, for all ages. The selection in the UK is getting much better, although I still feel hard done by when I compare the pickings in mainstream bookshops here, with what is available in France (along with regretting my lack of focus during French lessons at school).

Lynda Barry’s book “One! Hundred! Demons!” is excellent example of how a combination of images and text can communicate a narrative that would be impossible to tell through text alone. The book starts by Barry outlining how she was inspired by Zen Monk’s scroll painting of one hundred demons to experiment with letting her own inner demons to emerge from beneath her paintbrush onto the page.

The book is a collection of 17 vignettes or short stories of poignant life experiences that have shaped Barry, and continue to haunt her in some way. The stories are very moving, as well as bristling with philosophical and psychological questions about how we live our lives and relate to others. One of my favourite vignettes is entitled ‘Hate’. In this ‘Demon’ Barry ponders why it is that adults are so keen to rebuke and quash children’s expressions of hate without any understanding or exploration, even though it is clear that it is a core feeling we all experience. Barry recalls the honesty with which, as a child, she and her peers would express their feelings, “When we got mad we couldn’t hide it. It was normal to hate each other’s guts at times”. Expressing these deep feelings, however, was not acceptable to surrounding adults. As Barry puts it, ‘Eventually…everybody gets the “Hate Lecture”. In Barry’s storyline, it’s the mother of her friend who dishes this out following overhearing their fight: “The word Hate will not be tolerated in this house. Ever. Hear me?” a lecture which was swiftly followed by sending young Lynda home.

The vignette “Dogs” is also quite brilliant. On the surface, it’s a story about Barry’s experience with rehoming a shelter dog, Oola. Under the surface, it is a story that teachers and parents could also learn much from. Oola had experienced violence at the hands of a previous owner and arrives at Barry’s house aggressive and fearful. Barry describes liking the dog, but being unsure how to proceed with training. Overwhelmed with advice from dog training books, she and her husband set about using the various draconian methods recommended to establish the all important ‘dominance over dog’. Eventually, however, Barry realises that this ‘by the book’ treatment of Oola is not working. Treating Oola harshly was also entirely at odds with her own childhood experience that it was kindness and understanding by teachers that served as some kind of countermeasure to the cruelty Barry had experienced in her own home.

In her introduction, Barry ponders the question of what the book is: “Is it autobiography if parts of it are not true?” followed by, “Is it fiction if parts of it are?” The demon looming on the other side of the table as she ponders these questions seems not particularly interested in answering this conundrum; it stands waiting, needing to be to be drawn. And thereby understood.

Most of us have had the experience of getting outside into the natural environment—whether that is into the garden, to the local park or to the woods—and feeling a lot better as a result. The benefit of spending time in the outdoors is something that many people have commented on over the ages. John Muir, the Scottish-American naturalist and conservationist, for instance, wrote in 1901 that: “Thousands of tired, nerve-shaken, over-civilized people are beginning to find out that going to the mountains is going home; that wildness is a necessity”.

Although he was writing more than a century ago, Muir’s ideas were prescient. In our society, with an ever-growing emphasis on virtual worlds accessible through sophisticated technologies and with the world’s population increasingly living in built up urban areas, we tend to spend less and less time immersed in nature. Current research strongly support’s Muir’s notion that this trend of being out of touch with nature ‘shakes our nerves’ and wears us out.

For example, research clearly indicates that there are considerable positive health benefits in living in areas with accessible green spaces. A 2013 UK investigation for instance, evaluating the longitudinal effect of green spaces on mental health found that moving to a greener urban space was linked with sustained mental health improvements [1].

Other studies show that taking exercise in outdoor natural environments has positive effects on our mental well being. A UK 2011 review study found that exercising outdoors in a natural environment resulted in more long-lasting feelings of well-being, compared to exercising in an indoor environment [2].

Even more interestingly, a 2015 study conducted at Stanford University compared the effects of walking for 90 minutes in an urban space with walking for the same period of time in a natural environment.[3] The results of this study demonstrated that even after this brief experience of walking in a natural space, participants reported engaging in less rumination (repetitive thought focused on negative aspects of the self). There was also evidence of reduced activity in an area of the brain associated with depression following these walks in nature. This research aligns with the results of studies which have found that the kind of thinking that goes on in green spaces is more meditative and creative than the thinking we engage in when we are indoors [4].

Getting outside into the natural environment and making contact with flora and fauna does not have to take the form of exercise, of course. Other studies have shown equal and similar benefits to getting involved in activities like gardening, or doing arts and crafts in the outdoors [5].

It seems, therefore, that we need to take note of the necessity of getting into green spaces in our everyday lives–these excursions are not an added extra, but of central importance of to our sense of well being, and our capacity to engage in creative and productive thinking and doing. This notion is best narrated by the naturalist and philosopher Henry Thoreau, who wrote in 1862, ” I believe that there is a subtle magnetism in Nature, which, if we unconsciously yield to it, will lead us aright. It is not indifferent to us which way we walk” [6].

As a student, I once babysat for a local couple. I recall the experience as bemusing, for almost every available surface in the small house was covered with sticky notes on which were written rousing motivational slogans. It felt rather spooky walking about the house, and encountering endless exhortations. I still recall the one on the bathroom mirror that read ‘You WILL become a millionaire, within the next THREE years!’

That slogan captures a movement of striving for success and happiness that Oliver Burkeman wants to challenge, in his 2012 book ‘The Antidote’. His central argument is that the self-help movement, busy promoting pathways towards happiness, success and inner peace, is deeply flawed. The messages from these seminars and books, he points out, tend to be remarkably banal and have been shown to be ineffective at increasing our sense of wellbeing.

Indeed, it is this constant striving towards happiness, Burkeman argues, that is a source of deep distress in society. In place of this anxious striving, Burkeman suggests, we should be doing just the opposite. We should be giving up on the goal of setting goals in pursuit of success and happiness.

For Burkeman, in order to live a satisfyingly full life, we need a more complete palette of experiences and feelings: the good and the bad, the ugly, the happy and the sad. “The problem is” writes Burkeman, “we have developed the habit of chronically overvaluing positivity, and of the skills of ‘doing’, in how we think about happiness, and that we chronically undervalue negativity, and the ‘not doing’ skills, such as resting in uncertainty or getting friendly towards failure’ (p. 207).

In his search for people and practices where this ‘negative capability’ is embraced, Burkeman reviews Stoic philosophies, Buddhist meditational practices, and critiques the current mania on goal setting, and reducing risks and uncertainty. He also devotes a chapter, ‘Memento Mori’, to outlining the life-enhancing benefits of being in touch with our mortality.

Each chapter in the book can be read as a stand-alone text. They are both thought provoking, and in places very funny. Burkeman’s account of announcing tube stations on the Central line in London after being challenged to face his fear of public embarrassment by American psychotherapist Albert Ellis is a good example of how he draws together ideas, interviews, and his own experiences in writing. His recount of attending a 6-day silent meditation retreat in Massachusetts is both fascinating, and (somewhat ironically), a description that could motivate readers to take up meditation.

Living a life according to the ‘backwards law’ or ‘negative capability’ is not about giving up on good feelings, optimism, or striving to achieve things. Rather, it is more about relaxing our white-knuckle control upon determined ends, and being more attuned to the journey we are on, complete with ups and downs. If Burkeman had been in that house where I babysat all those years ago, I imagine he might have pulled out a pen, and rewritten the motivational slogan on the bathroom mirror to read “I don’t quite know where I will be in three years’ time, but wherever I end up, I am damn well going to enjoy the journey”.

The unpleasant feeling we get when bored, of being in some kind of empty space where time stretches endlessly forwards, is captured well in Charles Simic’s poem:

TO BOREDOMBy Charles Simic

I’m the child of your rainy Sundays.
I watched time crawl
Over the ceiling
Like a wounded fly.
A day would last forever,
Making pellets of bread,
Waiting for a branch
On a bare tree to move.
The silence would deepen,
The sky would darken,
As Grandmother knitted
With a ball of black yarn.
I know Heaven’s like that.
In eternity’s classrooms,
The angels sit like bored children
With their heads bowed.

Boredom has a variety of definitions, but in essence is a disagreeable mental state of being without stimulation, which oftentimes makes us feel very restless. Interestingly, different people seem to have a varying threshold of tolerance for boredom: some can manage to bear it for longer than others. People with higher thresholds of tolerance for boredom tend achieve better in education than those of us with lower thresholds. This might say something more about the structure of formal school than it does about boredom, of course. The sociologist Philip Jackson concluded in his famous study ‘Life in Classrooms’, after many hours of observation, that one of the main (but hidden) purposes of school was to get children used to being bored–thus preparing them for a life of boredom as workers.

In our everyday life the rapid advent of mobile technology means that we have very effective and efficient means at our fingertips to avoid being bored, almost wherever we go, at any time in the day. No longer do we have to sit on trains and buses people watching or gazing out of the window. Instead we can watch a TV programme, message friends, reply to emails and catch up with the news.

But is our now almost constant avoidance of boredom a good thing? Certainly, Bertrand Russell was concerned, well before the proliferation of so much mobile technology, that the growing public ‘allergy’ to boredom was equivalent to some kind of addiction to excitement. This constant pursuit of excitement did not leave room, Russell warned, to the kind of non-stimulated state of mind that he called ‘fructifying boredom’–a kind of ‘stillness of mind’ out of which creativity could flow. This assertion chimes with some recent research that shows that a state of boredom can actually generate more creative thinking (Mann and Cadman, 2014).

Putting these thoughts together, it seems that whilst too much boredom is not a good thing, evading all states of boredom could also be deleterious. For if we constantly stimulate our minds from the outside, we also avoid the possibility of experiencing fructifying boredom–a state of non-stimulation, into which ideas and feelings can float, coalescing in creative and playful ways. Our flight from boredom, therefore, could be a flight from parts of ourselves that need a free space in which to emerge, and a journey away from an inner space of play.

Mindfulness, a therapeutic practice with its roots in meditation, is increasingly being promoted as a means of achieving a range of health benefits—both physical and psychological. Essentially, mindfulness is a state of being, achieved by focusing attention on the present moment, observing, accepting and then letting go of any emerging thoughts, feelings, and bodily sensations. The methods by which attention can be focused on the present are various—including breathing exercises, meditation, observation, yoga, and art practices such as drawing, and origami.

The poem below, written by Rumi, the 13th century Persian poet and scholar, is often used by mindfulness practitioners to express this central idea of noticing, acknowledging and letting go of thoughts and feelings in the body.

The Guest House

This being human is a guest house.
Every morning a new arrival.

A joy, a depression, a meanness,
some momentary awareness comes
as an unexpected visitor.

Welcome and entertain them all!
Even if they are a crowd of sorrows,
who violently sweep your house
empty of its furniture,
still, treat each guest honorably.
He may be clearing you out
for some new delight.

The dark thought, the shame, the malice.
meet them at the door laughing and invite them in.

Be grateful for whatever comes.
because each has been sent
as a guide from beyond.

— Jellaludin Rumi, translation by Coleman Barks

The benefits of practising mindfulness seem to be that this intense focus on being in the present moment helps to connect us with our physiological and emotional responses to the world inside and around us, instead of our habitual way of going into ‘autopilot’ to cope with the many stresses and demands we face in our daily lives. In turn, this helps us to have the freedom to make more choices about how we respond to the world, rather than being ruled by old patterns.

There have, however, been criticisms of the upsurge in the way mindfulness is being promoted as a therapeutic practice. Key amongst these is that for some people (especially those who have encountered trauma) mindfulness practices can put them in touch with very difficult feelings that become overwhelming to cope with alone. Another criticism is that mindfulness is being promoted by employers and health providers because it is a much cheaper intervention, compared to other therapies such as counselling or CBT.

As with any kind of therapy, it is important to find a good practitioner to work with, and also to keep in mind that any intervention that presents itself as a ‘one size fits all’ needs to be viewed with a very careful critical eye. The following links provide more information about mindfulness—what it can offer as well as its limitations.